Atrial fibrillation (AF) is associated with significant morbidity and mortality, particularly in the aging population. However, the epidemiology and understanding of modifiable risk factors in AF are poorly understood. While there are some studies reporting sex differences in atrial fibrillation (AF) epidemiology,1,2 further research is needed. To address this, a substudy of the BiomarCaRE consortium, recently published in Circulation, analysed available data on AF from 79,793 individuals.3 The study objective was to systematically examine sex differences in the incidence of atrial fibrillation and also investigate the association of AF with mortality and cardiovascular risk factors.
The study sample had an overall median age of 49.6 years (age range 24.1–97.7 years) and included 51.7% women. At baseline, women had a lower average body mass index (BMI) and systolic blood pressure than men. The median follow-up time was 12.4 years (range 0–29 years). Over this time period, significantly fewer cases of AF were observed in women (4.4%, n=1796) than in men (6.4%, n=2465; p<0.001). Interestingly, when the group investigated the cumulative incidence of AF, they found that it increased markedly after 50 years of age in men and after 60 years of age in women. However, in old age (90 years of age) the cumulative risks were comparable. The study also revealed that subjects with incident AF had a 3.5-fold increased risk of mortality, regardless of sex, than those without AF. Among the classical cardiovascular risk factors, increased BMI was linked to an greater risk of atrial fibrillation in both men and women, with a larger effect in men (31% increased risk) compared with women (18% increased risk).
Understanding of sex differences in AF is crucial for the development of preventative strategies to reduce the increased public health and economic burden associated with the condition. From these data, it is clear that AF poses a significant risk in terms of premature mortality. However, BMI is a modifiable risk factor, providing an opportunity for risk reduction in both sexes.
Disclosure: Emma East is an employee of Touch Medical Media.
1. Schnabel RB, Wilde S, Wild PS, et al. Atrial fibrillation: its prevalence and risk factor profile in the German general population. Dtsch Arztebl Int. 2012;109:293–9.
2. Lip GY, Laroche C, Boriani G, et al. Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Observational Research Programme Pilot survey on Atrial Fibrillation. Europace. 2015;17:24–31.
3. Magnussen C, Niiranen TJ, Ojeda FM, et al. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588–97.